American International College Programmatic Relevance & Target Population Discussion Business Finance Assignment Help

Question 1:

For a $10 million office building project, the design documents are 60% complete. The owner has

decided to bring a construction management firm onboard to assist in the preconstruction and

construction phases of the project.

The owner advertised the Request for Proposals (RFPs), received written proposals from two (2)

potential firms, Firm A and Firm B. Both the firms are equally qualified in terms of experience,

references, financial capability etc. and have worked with the owner successfully on previous

projects.

Firm A is proposing a cost-plus-fee contract with 10% fee on top of its estimated cost of $250 per

hour. On the other hand, Firm B is proposing a CM-at-risk style contract with a guaranteed

maximum price (GMP) of $7 million.

The remaining design of the project is expected to complete in the next 6 months and the

construction duration of the project is expected to be 24 months. The completion of the project

on schedule is very important to the Owner and needs to be strictly obeyed by all the parties.

For your information, construction typically costs about 80% of the total project cost.

1. Based on the above scenario, which firm should the owner award the contract for the CM

services? Explain your answer from owner’s perspective of managing risk and weighing in

advantages/disadvantages of each approach. (Word Limit: 300 words)

2. If base rate for a Resident Engineer is $100 per hour for Firm A and $150 per hour for Firm B.

What will be their billed labor rates for Resident Engineer based on cost plus fee contract

with 10% fee?

3. If the owner proceeds with Firm B (CM-at-risk) what are the possible advantages and

disadvantages of this approach from owner’s perspective? (Word Limit: 250 words)

Question 2:

The design phase of a construction project is expected to take 24 months and the construction

timeframe is also expected to take 24 months. Owner decided to use design-build (DB) project

delivery method and divided the design phase into three (3) equal sub-phases. Similarly, the

construction phase was divided into three (3) equal sub-phases and each sub-phase began

after completion of the corresponding design sub-phase.

1. What is the total duration of this project? Show your work in the form of bar diagram.

2. What would be total project duration if the owner used typical design-bid-build delivery

method?

Chronic Stable Angina

E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina.

Diagnosis: Angina

1. List specific goals of treatment for E.H.

2. What dietary and lifestyle changes should be recommended for this patient?

3. What drug therapy would you prescribe for E.H. and why?

4. How would you monitor for success in E.H.?

5. Describe one or two drug–drug or drug–food interactions for the selected agent.

6. List one or two adverse reactions for the selected agent that would cause you to change therapy.

7. What would be the choice for the second-line therapy?

8. Discuss specific patient education based on the prescribed first-line therapy.

9. What over-the-counter and/or alternative medications would be appropriate for E.H.?

***Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers. All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History: Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1. According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2. Does he need medication(s) given his history of MI?

3. Considering that you have a case study, you only need 2 posts for this discussion board, 1 initial and 1 reply. As usual, all posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited.

***A minimum of 6 paragraphs is required for all posts. Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years).All posts are to be written in APA 6th edition format as required by the university.

I’m working on a Computer Science question and need support to help me study.

* note that the way the default constructored is coded, such that

 * 1) the head is a sentinel node with two pointers and the head does not store data value
 * 2) the list goes two directions: next and previous
 * Fully test each member function before you work to implement the next one
 */
 
 #include <iostream>
 using namespace std;
 
 struct node {
 int data;
 node *prev;
 node *next;
 };
 
 class lista {
 public:
 lista() {head = new node; head->next = head; head->prev = head;}
 
 // insert a new element at the beginning of the list, right before its current first element. The content of val is copied to the inserted element
 void push_front(const int &val) 
 { 
 node * np; 
 np = new node;
 np->data = val;
 
 np -> next = head -> next;
 head -> next -> prev = np;
 np -> prev = head;
 head -> next = np;
 
 }
 
 void push_back(const int &val);
 
 // remove the first element in the list container, effectively reducing the size by one
 void pop_front() {
 node *np = head->next;
 
 head->next = head->next->next;
 head->next->prev = head;
 
 delete np;
 }
 
 void pop_back();
 
 // return a reference to the first element in the list container
 const int& front() const { return head->next->data;}
 const int& back() const;
 
 // We use this friend function to show the contents of the list
 friend void display_list(const lista &obj);
 
 // return the number of elements in the list container
 int size() const;
 
 // returns whether the list container is empty
 bool empty() const;
 
 // remove all elements from the list container (which are destroyed), leaving the container with a size of 0
 void clear();
 
 private:
 node * head;
 };
 
 void display_list(const lista &obj)
 {
 node* np;
 
 np = obj.head->next;
 
 cout << "begin of the list.. " << endl;
 while (np != obj.head) {
 cout << np->data << endl;
 np = np->next;
 }
 cout << "end of the list.. n" << endl;
 
 }
 
 int main()
 {
 lista mylist;
 
 display_list(mylist);
 mylist.push_front(5);
 display_list(mylist);
 mylist.pop_front();
 display_list(mylist);
 mylist.push_front(5);
 display_list(mylist);
 cout << "the content of the first element in the list is: " << mylist.front() << endl;
 // cout << "the size of the list is: " << mylist.size() << endl;
 // cout << "the list is empty is: " << mylist.empty() << endl;
 // mylist.clear();
 // display_list(mylist);
 
 }